Trends in Pharmacological Sciences

November 1983

Setting instructional objectives

for a pharmacology course for medical students

A department of basic pharmacology in a medical school is subject to continual chal- lenge by clinicians with regard to the prob- lem of relevance of the teaching to the needs of medical students. We have been forced to face this challenge over the years and have found that careful attention to the pharmacology curriculum for medical stu- dents is mandatory if the pharmacology department is to retain its important posi- tion in the medical school. We have found that the setting of instructional objectives has been useful in the achievement of our goals.

As teachers of pharmacology, we are often presented with the problem of teach- ing large numbers of students in a variety of professional (medical, dentistry, phar- macy, nursing) and nonprofessional pro- grams. Often, in departments with small numbers of academic staff, several pro- grams are combined and students with dif- ferent aspirations are taught in a single class. When I began teaching pharmacol- ogy at the University of Alberta in Edmon- ton in 1962, approximately 200 medical, dental and pharmacy students were taught pharmacology in one, large class. At Queen's University in Kingston in 1972, medical and life sciences students were

taught in a class of 120 students. The ques- tion that arises is: are students learning optimally in such a setting or would it be preferable to teach students in separate clas- ses directed to the interests of the particular professional or science group? The ques- tion becomes particularly important when financial resources are limited and teaching individual courses requires additional academic staff.

Several years ago, with the aid of my col- leagues at Queen's University and guided by Mager's I work on 'Preparing Instruc- tional Objectives', I prepared a set of instructional objectives for our medical pharmacology course which are listed below.

Instructional objectives and evaluation of medical pharmacology

At the conclusion of the course, the stu- dent shall: (1) Be able to select the important pro- totype drug from a group of drugs. (2) Be able to list the properties of each pro- totype drug, namely: therapeutic effect, optimal route of administration, major toxic effects and contra-indications, mechanism of action, interaction with other drugs. (3a) Before considering the use of a new

drug or a new use for an old ~ ,.,~ that he understands all factors nece its safe and optimal use. (3b) Derive his/her new information on drugs from an unbiased source, such as the Medical Letter on Pharmacology and Therapeutics. (4) Be aware of the different mechanisms of drug toxicity, namely, overdose, allergic (immunologic) reaction, pharmacogenetic reaction, predictable extension of inherent pharmacological properties, and the appropriate measures to counteract these toxicities.

(5) Attempt to define the therapeutic end.. point of a drug, to avoid a toxic end-point.

(6) Be aware of the toxic effects to be anti- cipated from a drug and be able to describe suitable counter measures.

(7) Be able to weigh the therapeutic benefit against the toxic potential of a drug. (8) In the case of drugs with serious toxic potential, describe tests which allow early detection of adverse effects. (9) Describe possible factors which might increase hazards of drug administration or modify drug action, e.g. impaired renal function, impaired hepatic function, age and weight, history of drug sensitivity, drug-drug interaction, pregnancy, co- existent disease states, drug dependence potential, suicide potential. (10) After consideration of the phar- macokinetic properties of a drug, be able to administer it at the appropriate dosage and appropriate intervals. (11 ) Be aware that there is no such thing as a 'usual' dose of a drug and that the appro- pilate dose for different individuals can be markedly different.

~) 1983 FAsev~r Sc~ Pubhshe~ B V . Amatetdm11 0165 - 6147/83/$01 00

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(12) After consideration of the nature of a disease, be aware of the appropriate time period for the administration of a drug. (13) Be able to choose the appropriate route of drug administration. (14) Be aware of the problems of 'bioavailability' and not switch from one preparation to a second without due consid- eration of the problems which could arise.

Evaluation o f objectives 1-14 The above objectives will be tested in two multiple choice examinations. Students will be required to read the Medical Letter and answer questions from this publication. A mid-semester examination will count for 25 % of the final mark. A final examination will count for 40% of the final mark. Stu- dents will be required to obtain a minimum grade of 60% in these multiple choice examinations in order to pass the phar- macology course.

(15) Be aware of the evidence for the effi- cacy of a drug. (16) Be aware of alternative drug therapy and be sure to select the drug(s) of choice. (17) Assess papers describing drug trials by asking the following questions: (a) was the drug compared with a placebo or with a standard drug in an appropriately designed trial? (b) Were patients assigned randomly to various treatment groups? (c) What pre- cautions were taken to exclude subjective bias, especially during evaluation proce- dures ? (d) Were the patients included in the trial typical of those for whom the drug is now recommended? (e) Are the results claimed for the drug statistically signifi- cant? (18) Recognize techniques of persuasion utilized in the construction of drug adver- tisements. (19) Identify inaccuracies in drug advertis- ing.

Evaluation o f objectives 15-19 Students will be provided with an adver- tisement for a drug or combination of drugs. They will be required to assess this advertisement by reading and evaluating the drug trials on which the claims for the drug rest. Students will write a short essay and present a brief (5 min) summary of their findings in small group sessions. This project will count for 10% of the final mark. Students will be expected to obtain 60% in order to pass this project.

(20) Use non-proprietary names for drugs rather than brand names, with an under- standing of the advantage of adopting this practice. (21) Consider the cost of the drug when making a selection. (22) Use single drugs in preference to drug

combinations, unless there is a clear reason for the combination. (23) When using a drug combination, be aware of the nature of the constituents and their pharmacological properties. Only use fixed ratio combinations when the ratio of constituents is appropriate. (24) Be familiar with the problems of patient 'compliance' with drug regimens. (25) Write appropriate prescriptions with clear instructions and be able to review medication instructions carefully in order to facilitate patient compliance. (26) Be familiar with the drug evaluations contained in The Medicine Show pub- lished by Consumer Reports.

Evaluation o f objectives 20-26 Students will be examined to see if they attained the above objectives. This exami- nation will count for 7.5% of the final mark. Students will be expected to obtain at least 60% to pass this project.

(27) Be able to describe the problem of psychotropic medical and non-medical drug use in Canada. (28) Be able to describe the various treat- ment modalities for the problem of psycho- tropic medical and non-medical drug use.

Evaluation o f objectives 2 7-28 Students will be required to read several references in this field and will be examined to see if they have attained the above objec- tives. This examination will count for 7.5 % of the final mark. Students will be expected to obtain at least 60% in order to pass this section of the course.

(29) Be able to differentiate muscarinic, nicotinic, at-adrenergic, a2-adrenergic, fll-adrenergic, flz-adrenergic, H~- and Hvhistaminergic receptors. (30) Be able to differentiate between the various agonist and antagonist autonomic drugs. (31) Have demonstrated sufficient familiar- ity with scientific method and reasoning to devise a procedure for identifying an unknown autonomic drug.

Evaluation o f objectives 29-31 Students will be given an unknown auton- omic drug to identify. Two laboratory ses- sions will be devoted to this project and stu- dents will write a report on their findings. This project will count for 10% of the final mark in the course and a pass mark in the project will be 60%.

Summary of evaluations Mid-semester examination 25 % Final examination 40% Drug literature evaluation 10% Essay examination on non-medical drug use 7.5%

TIPS -November 1983

Autonomic unknown 10% Test on rational and irrational drug combinations 7.5 %

Having set these instructional objectives, which we believe to be appropriate for med- ical students, it became clear to us that, while some of these objectives were also appropriate for life sciences students, many were inappropriate. Thus it was apparent to us that medical and life sciences students should be taught in separate classes. Moreover, these instructional objectives for medical students have influenced the evolu- tion of our teaching to medical students. For example, two 3 h problem-solving sessions on pharmacokinetics were introduced. In addition, five 3 h problem- solving sessions, conducted jointly with clinicians, were introduced on the follow- ing topics: drugs used in haematology, cancer chemotherapy, diuretics, psycho- pharmacology and neuropharmacology. A project has been introduced on 'Rational and Irrational Drug Combinations' and the problem of psychotropic medical and non-medical drug use has been emphas- ized.

It was clear that many of these new pro- jects for medical students were inappropri- ate for life sciences students. Since many of our life sciences students were headed for laboratory-based careers in pharmacology, it was apparent that the laboratory-based portion of the pharmacology course needed strengthening. Moreover, it was clear that the mechanisms of action of drugs required emphasis. Thus the setting of instructional objectives for each course, while by no means an educational panacea, has proved useful in clarifying our thinking and guid- ing our curriculum development. We hope that these objectives may be useful to others.

We have found that medical students are considerably more appreciative of a phar- macology course perceived to be directed to their specific needs and aspirations. This, in turn, strengthens the position of a basic pharmacology department in the Byzantine political environment of a medical school. Moreover, the life sciences students are also more appreciative of a pharmacology course directed to their aspirations. I believe that insistence on teaching a laboratory and science-based course in pharmacology without attention to the needs of medical students can seriously weaken the status of a pharmacology department in a medical school.

GERALD S. MARKS

Department of Pharmacology and Toxicology, Queen's University, Kingston, Canada, KTL 33!6.

Reference 1 Mager, R. F. (1962) Preparing Instructional

Objectives, Fearon PubFmhers, Belmont, California